Gliederung

Objective: Recent investigations documented that extreme blood pressure (BP) values are known to correlate with a poor outcome in patients suffering from stroke. The goal of the present study was to examine the influence of blood pressure variability on the short-term outcome of patients after traumatic brain injury (TBI).

Methods: All patients treated for TBI on our neurosurgical intensive care unit (ICU) between January 2003 and June 2007 were integrated in this retrospective analysis. The neurological status according to the Glasgow coma scale (GCS), the systolic blood pressure (SBP), the diastolic blood pressure (DBP), the mean arterial blood pressure (MAP), the intracranial pressure (ICP) and the cerebral perfusion pressure (CPP) were continuously recorded with an automated documentation software (CareVue, Philips Medical). Maximum, minimum, mean and range of BP and CPP, and successive variation for systolic, diastolic and mean BP were calculated, correlated to clinical data (GCS and Glasgow outcome scale, GOS), and statistically analyzed.

Results: 271 patients (202 male, 69 female) with a median age of 53.1 years and a median ICU abidance of 7.6 days were examined retrospectively. All patients were treated equally according to our protocol for patients with TBI. Improvement was defined as a higher level of GCS on discharge than on admission. Range of systolic and diastolic BP was significantly smaller in patients with a GOS of 5 (p=0.000), but did not correlate with an improvement during ICU stay (p=0.477). High systolic pressure correlated negatively with a good outcome (GOS 5, p=0.000). Low variation of systolic BP correlated with a GOS of 5 (p=0,000), high variation correlated highly significantly with a lethal outcome (p=0,000).

Conclusions: High SBP and large range of SBP seem to be indicators and predictors of a complicated course in patients after TBI. Based on this data further investigations focusing on the hemodynamic management of patients after TBI are necessary.